MEDICINE 6TH LE A.Y. 2011-2012 d.

Lung cancer is the leading cause of cancer-

related deaths in the country
1. Which of the following is an example of the loss of
sensitivity to growth inhibitory signals in the development 10. Which of the following malignancies is associated
of cancer? with a known environmental risk factor?
a. Mutations in the ras gene a. Lung cancer
b. Mutations in the p53 gene b. Breast cancer
c. Elaboration of the vascular endothelial growth factors c. Uterine cancer
d. DNA amplification of the epidermal growth factor d. Prostate cancer
receptor gene
11. Primary prevention is applicable in which of the
2. Which of the following is associated ONLY with tumor following?
suppressor genes? a. Liver cancer
a. Nowells hypothesis b. Breast cancer
b. Knudsons hypothesis c. Ovarian cancer
c. Microsatellite instability d. Prostate cancer
d. Mendellian cancer syndromes
12. Which of the following is necessary characteristic of a
3. In a patient diagnosed to have lung cancer, which of the screening test?
following suggests the presence of an aggressive tumor? a. The screening test is available only in a
a. Tumor blood vessels are few in number and of small large, tertiary medical hospitals
caliber b. The malignancy is ranked 18th among
b. Clubbing of the hands and feet are noted on physical leading causes of cancer in the country
examination c. The test involved requires the use of
c. Hemoptysis of about 1 teaspoon/day is prominent in sophisticated, computerized equipment
the patients history d. The screening procedure is simple and does
d. The patient claims to have lost <50% of his body not cause discomfort to patients
weight in less than 2 months
13. Which of the following represents an example of
4. Which of the following statements is TRUE with regards to cancers mass effects?
the log phase of the Gompertzian growth curve? a. Hodgkins lymphoma presenting with fever
a. May be used as a clinical indicator of tumor and night sweats
aggressiveness b. Colon cancer presenting with constipation
b. Tumor doubling is slow and may be measured in and hematochezia
months c. Pancreatic cancer presenting with 40%
c. Majority of tumor cells are in the G0 phase of cell weight loss in 4 months
cycle growth d. Adenocarcinoma of the lung presenting with
d. During this phase, cells are least sensitive to clubbing of the digits
anticancer chemotherapy
14. In which of the following should you suspect a
5. A biopsy was taken from an esophageal mass. Which of possible paraneoplastic syndrome?
the following would be consistent with the findings of a. Gastric cancer patient who reports early
malignancy? satiety and postprandial vomiting
a. Cells have an abundant cytoplasm b. Non-small cell lung cancer patient
b. The cells appear hyperchromatic complaining of insomnia and depression
c. Each cell has no more than 1 nucleolus in its nucleus c. Breast cancer patient expressing frustration
d. No encroachment of adjacent basement membranes and anger because of recurrence
is noted d. Small cell lung cancer patient who develops
weight gain, acne and facial edema
6. Which of the following is consistent with the promotion
phase of carcinogenesis? 15. In which condition should one suspect that an early
a. Effects are genotoxic warning sign of cancer is present?
b. Damage is irreversible a. 47 year old female with crampy abdominal
c. The end result is a mutated cell pain and diarrhea
d. Process takes a long period of time b. 60 year old male who consults for gross
hematuria and flank pain
7. Which of the following tumors may be linked to a lifestyle- c. 23 year old female who reports a one month
related carcinogen? loss of menstruation
a. Osteosarcoma d. 55 year old male with complaints of urinary
b. Esophageal cancer frequency and polyuria
c. Non-hodgkins lymphoma
d. Nasopharyngeal carcinoma 16. A 66 year old male with a chronic alcoholic history is
brought to you for severe icterisia. Physical
8. After exposure to a very high dose of radiation, which of examination reveals a nodular liver, tender to direct
the following would have the HIGHEST risk of developing palpation. He reports anorexia, weight loss and low
into a malignancy? grade afternoon fever. Relatives complain that he has
a. Skin been very moody, with behavior alternating between
b. Liver bouts of anger and episodes of depression. Of the
c. Breast above findings, which of the following would be
d. Stomach consistent with the mass effects of the cancer?
a. Anorexia
9. Which statement best reflects the cancer situation in the b. Jaundice
Philippines? c. Weight loss
a. Cancer is the leading cause of illness in the country d. Depressive moods
b. Liver cancer is the leading cause of cancer in Filipino
males 17. A 50 year old male with a history of chronic Hepatitis
c. Lung cancer is the leading cause of cancer in B infection is discovered to have a mass in the right
Filipino females lobe of the liver on abdominal ultrasound. If you
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 suspect malignancy, which of the following is the
BEST way of proving it?
a. Liver function tests
b. FNAB of the liver mass
c. Serum AFP
d. MRI or triphasic CT scan of the liver
18. A 52 year old male who was diagnosed as a case of
renal cell carcinoma develops tumor recurrence 6
months after a nephrectomy had removed the
primary site from the left kidney. Work-up revealed
metastatic nodules in both the lungs and liver. He is
treated with the new targeted agent Sorafenib and
after a year of intake, has shown marked
improvement in all his symptoms. A repeat ultrasound
of the liver and x-ray of the lungs, however, shows no
changes in the baseline size and number of the
metastatic nodules. Which modality could BEST
reflect the response of the tumor to this new
therapeutic agent?
a. Whole body PET scan
b. MRI of the chest and abdomen
c. CT scan of the chest and abdomen
d. Biopsies of the lung and liver nodules
19. In which of the following situations would CURE be
the objective of the management plan?
a. Osteosarcoma patient with multiple nodules
on chest x-ray
b. Breast cancer patient with osteoblastic
lesions in the bone scan
c. Non-small cell lung cancer patient with
severe headache and vomiting
d. Colon cancer patient with negative nodal
metastases on pathologic exam
20. Which of the following situations would decrease the
chances of achieving cure in the management of a
cancer patient?
a. Primary tumor is 1 cm in size
b. Bone scan shows degenerative arthririts
c. Primary tumor is located in retroperitoneum
d. 1 regional node is positive for metastatic
disease
21. A 45 year old female is diagnosed to have breast
cancer. Her left breast harbors a 2x1.5 cm hard, fixed
mass. Examination of the axillary area reveals 2
hard, non-tender nodes of 1.5 cm in size. Metastatic
work-up shows no involvement of distant sites. Which
would you recommend as the BEST plan for this
patient?
a. Systemic chemotherapy
b. Surgery followed by systemic therapy
c. Surgery followed by radiation therapy
d. Radiation therapy followed by surgery
followed by systemic therapy
22. Which of the following should be done in establishing
communication between the physician and the
cancer patient?
a. Consult with relatives on what and what not
to tell the patient
b. Circumvent any discussion that doesnt
involve medical problems
c. End every visit with the patient with an
invitation to ask questions
d. Avoid disclosing diagnosis, even when
asked, to prevent depression
23. In a patient with intermittent pain, occurring one or
two times a day, with a visual analogue scale score
of 3-4, which agent would be your first choice?
a. Ibuprofen 500 mg every 6 hours
b. Tramadol HCl 50 mg every 6 hours
c. Morphine sulfate 10 mg every 4 hours
d. Any of the above
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24. A 65 year old patient with colon cancer and multiple
metastases to the liver, bone and lungs is referred to
you for management. He is malnourished and totally
bed-ridden. The family asks you what your plan of
management would be. You tell them that you have
decided to defer systemic chemotherapy and
concentrate on symptomatic care alone as you feel
he may not be able to withstand the side effects.
However, the patient insists on receiving systemic
therapy despite your warnings to the contrary.
Despite your misgivings, you agree to the procedure.
Which bioethical principle are you following in this
case?
a. Justice
b. Beneficence
c. Non-maleficence
d. Respect for autonomy
25. Which of the following represents the most important
goal of palliative therapy in the terminally-ill cancer
patient?
a. Prolongation of survival
b. Improvement in quality of life
c. Decrease in the size of the tumor
d. Decrease in the number of metastatic sites
26. Which pharmacologic aspect of cancer
chemotherapy determines the method of
administration of the drug?
a. Excretion
b. Absorption
c. Distribution
d. Bio-transformation
27. Which of the following is consistent with the
Fractional cell kill hypothesis?
a. Chemotherapy becomes effective only in
cells that are actively dividing
b. Resistance to cell kinetics may be overcome
by prolonged infusion of the drug
c. Effective systemic therapy of cancer entails
multiple therapies that are given on time
d. Combination of different agents would be
most effective if they work on different areas
of the cell cycle
28. A patient with colon cancer and liver metastasis is
scheduled to receive systemic chemotherapy with 5-
flourouracil, an S-phase specific drug. Which of the
following strategies will improve the response of the
tumor to this agent?
a. Increase the total dose of the drug
b. Give the drug as a daily bolus injection
c. Administer as a continuous infusion over 24
hours
d. Decrease the intervals between drug
administration
29. Vincristine is a mitotic spindle poison that exerts its
effect in the M phase of the cell cycle. This is an
example of which of the following?
a. Cycle non-specific drug
b. Cycle-specific, phase specific drug
c. Cycle specific, phase non-specific drug
d. Drug active against resting, non-dividing
cells
30. Which of the following would be an effective way of
potentially overcoming resistance due to cancer cell
kinetics?
a. Use chemotherapy combinations in very
high doses followed by blood cell re-growth
stimulators
b. Utilize drugs capable of penetrating potential
sanctuary areas where tumor cells may
escape their effects
c. Resistance from cancer cell kinetics usually
occurs naturally in a tumor mass and is
practically difficult to overcome
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 d. Combine multiple treatment modalities such
as surgery followed by systemic therapy to
target cells with different growth rates
31. Which of the following situations is NOT a true
example of drug resistance of cancer cells?
a. Tumor cells have acquired the multi-drug
resistance gene
b. The patient is a rapid metabolizer of anti-
cancer agents
c. The patient presents with a very large,
necrotic, foul smelling primary tumor
d. The Goldie-Coldman hypothesis on
occurrence of resistance in a proliferating
tumor mass
32. Which of the following is the main indication for
neoadjuvant anticancer chemotherapy?
a. Overcome resistance due to cell kinetics
b. Decrease the incidence of acquired
resistance
c. Control micrometastases present in
sanctuary sites
d. Facilitate a less aggressive from of surgical
procedure
b. Systemic therapy of metastasic
adenocarcinoma of the prostate
c. Treatment of increased intracranial pressure
in brain metastasis
d. Temporizing management of superior vena
cava syndrome in lung cancer
38. Which of the following represent the use of a
monoclonal antibody targeting anglogenesis in order
to control the malignant phenotype?
a. Bevaclizumab in metastatic colorectal
cancer
b. Ipilimumab in metastatic malignant
melanoma
c. Rituximab in CD20 (+) non-hodgkins
lymphoma
d. Trastuzumab in Her2 (+) metastatic breast
cancer
39. Which of the following is an example of active,
specific immunotherapy in cancer?
a. Interferons and interleukins
b. Monoclonal antibodies
c. Cancer vaccines
d. Dendritic cell therapy

Case for nos. 33-35: a 52 year old male is diagnosed to have
adenocarcinoma of the right lung. After being referred to you,
a staging work-up reveals the following: primary lesion on
chest and abdomen CT shows a 6x5 cm mass at the right
mid-lung about 150cc effusion on the right; 3 lesions in the
liver noted on ultrasound, measuring 1x1 cm, 2x1 cm and 3x2
cm each at the right lobe; multiple bone metastases involving
the thoracic and lumbar spine, 3 ribs on the left, the left hemi-
pelvis, and the left mid-shaft of the femur. Physical exam also
showed a palpable right supraclavicular node measuring 2x2
cm.
33. Which of the following would you designate as a non-
measurable lesion?
a. Liver nodules
b. Right pleural effusion
c. Right supraclavicular node
d. Mass at the right mid-lung
40. Which of the following statements would be
consistent with the evolving concept of palliative
care?
a. Palliative care begins the moment active
anti-cancer therapy has failed
b. Important problems must be recognized
early and evaluated comprehensively
c. The cancer patient is the sole recipient of
the benefits from palliative care
d. There is no need of informing the patient of
prognosis in order to avoid emotional trauma
---end of part 1---

34. What is the sum of the longest diameter of all the

target lesion?
a. 14 cm
b. 12 cm
c. 13 cm
d. 11 cm

35. The patient completed 6 cycles of chemotherapy and

re-evaluation revealed the following: right mid-luing
lesion 3x2 cm; no change in the size of the liver
nodules with 2 new lesions noted on the left lobe of
the liver, 1 cm in size for each; disappearance of the
pleural effusion on the right; no change in bone
metastasis; disappearance of the right
supraclavicular node. How would you grade the
overall response of the treatment?
a. Stable disease
b. Partial response
c. Complete response
d. Progressive disease

36. Additive hormonal therapy is applicable in which of

the following situations?
a. Skin metastasis in ER+ breast cancer
b. Locally advanced endometrial cancer
c. Anti-emetic therapy in cancer chemotherapy
d. Regional lymph node metastasis in prostate
cancer

37. Ablative hormonal therapy can be seen in which of

the following circumstances?
a. Alleviation of the spinal cord compression
due to bone metastasis

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